How collaboration in therapy becomes therapeutic: the therapeutic collaboration coding system

Abstract

Background. The quality and strength of the therapeutic collaboration, the core of the alliance, is reliably associated with positive therapy outcomes. The urgent challenge for clinicians and researchers is constructing a conceptual framework to integrate the dialectical work that fosters collaboration, with a model of how clients make progress in therapy. Aim. We propose a conceptual account of how collaboration in therapy becomes therapeutic. In addition, we report on the construction of a coding system – the therapeutic collaboration coding system (TCCS) – designed to analyse and track on a moment-by-moment basis the interaction between therapist and client. Preliminary evidence is presented regarding the coding system’s psychometric properties. The TCCS evaluates each speaking turn and assesses whether and how therapists are working within the client’s therapeutic zone of proximal development, defined as the space between the client’s actual therapeutic developmental level and their potential developmental level that can be reached in collaboration with the therapist. Method. We applied the TCCS to five cases: a good and a poor outcome case of narrative therapy, a good and a poor outcome case of cognitive-behavioural therapy, and a dropout case of narrative therapy. Conclusion. The TCCS offers markers that may help researchers better understand the therapeutic collaboration on a moment-to-moment basis and may help therapists better regulate the relationship.